2024-06-27-MLNC

CMS released technical FAQs for pharmacies (PDF) about the Preexposure Prophylaxis (PrEP) Using Antiretroviral Drugs to Prevent HIV National Coverage Determination (NCD), which we expect to release in late September 2024. We got public feedback asking us to release more technical information on how to submit future Medicare Part B claims in advance of the final NCD.

We expect the final NCD will be similar to the proposed NCD that was published on July 12, 2023, and pharmacies should prepare now for this transition. We’re sharing as much information as possible before issuing the final NCD to avoid disruptions for people with Medicare.

More Information:

Claims, Pricers, & Codes

Medicare Part B Drug Pricing Files & Revisions: July Update

Learn about quarterly updates to the following average sales price and not otherwise classified pricing files:

July 2024
April 2024
January 2024
October 2023
July 2023

More Information:

HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement: July 2024 Update

See the instruction to your Medicare Administrative Contractor (MAC) (PDF) to learn about the July update to codes excluded from skilled nursing facility consolidated billing, including:

Caregiver training effective January 1, 2024
Enhanced oncology services effective July 1, 2023

MACs will adjust claims you bring to their attention.

Events

2024 Virtual National Provider Compliance Conference — August 7 & 8

Wednesday, August 7 and Thursday, August 8, 2024, from 12–4 pm ET

Join CMS for this virtual conference that will:

Feature expert presentations on Medicare Fee-for-Service claims
Provide a unique learning and networking opportunity

Target audience: Anyone who processes Medicare Part A and Part B, home health, hospice, or DME claims, including physicians, non-physician practitioners, billing specialists, suppliers, associations, coders, and medical review contractors.

MLN Matters® Articles

DMEPOS Fee Schedule: July 2024 Quarterly Update

Learn about fee schedule updates (PDF):

CY 2024 amounts for certain codes, including rural ZIP Codes effective July 1, 2024
Payment policy changes effective July 1, 2024
New information for HCPCS codes K1007 and E2298 effective April 1, 2024

Your Medicare Administrative Contractor will adjust claims for code E2298 with dates of service on or after April 1, 2024, that you bring to their attention.

Multimedia

Medicare Ground Ambulance Data Collection System: Webinar Recordings

CMS posted recordings from updated Medicare Ground Ambulance Data Collection System Instrument webinars:

From Our Federal Partners

Increased Risk of Dengue Virus Infections in the U.S.

The CDC issued a Health Alert Network Health Advisory to notify health care providers, public health authorities and the public of an increased risk of dengue virus (DENV) infections in the U.S. in 2024. Global incidence of dengue in 2024 has been the highest on record for this calendar year; many countries are reporting higher-than-usual dengue case numbers. In 2024, countries in the Americas have reported a record-breaking number of dengue cases, exceeding the highest number ever recorded in a single year. From January 1 – June 24, 2024, countries in the Americas reported more than 9.7 million dengue cases, twice as many as in all of 2023 (4.6 million cases). In the U.S., Puerto Rico has declared a public health emergency (1,498 cases) and a higher-than-expected number of dengue cases have been identified among U.S. travelers (745 cases) from January 1 – June 24, 2024. In the setting of increased global and domestic incidence of dengue, health care providers should take steps including:

Have increased suspicion of dengue among people with fever who have been in areas with frequent or continuous dengue transmission within 14 days before illness onset
Order appropriate diagnostic tests for acute DENV infection: reverse transcription polymerase chain reaction [RT-PCR] and IgM antibody tests, or non-structural protein 1 [NS1] antigen tests and IgM antibody tests
Ensure timely reporting of dengue cases to public health authorities
Promote mosquito bite prevention measures among people living in or visiting areas with frequent or continuous dengue transmission

See the full Health Advisory for more information.

Health Care Preparedness Resources

The Administration for Strategic Preparedness and Response's Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) released new and updated health care preparedness resources, which could help you comply with some of the CMS emergency preparedness requirements:

Health Care Facility Extreme Weather Resilience and Mitigation recording: discusses how to incorporate lessons learned from past disasters in the design or retrofitting of climate-resilient facilities
On-Campus Health Care Facility Armed Assailant Planning Considerations checklist: helps planners prepare their facilities to mitigate, respond to, and recover from an active shooter or armed assailant situation on campus
Medical Operations Coordination Centers Toolkit (Version 3.0): suggests how to optimally-balance patients across health care facilities and systems
LGBTQI+ Community Members and Disaster Preparedness and Response Topic Collection: highlights key considerations for LGBTQI+ populations and the health care providers and preparedness planners who serve them during and after a disaster

More Information:

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